Posterior sagittal anorectoplasty in anorectal anomalies
clinical, manometric and profilometric evaluation
Keywords:
Child, Anal canal, Imperforate anus, Manometry, Fecal incontinenceAbstract
CONTEXT AND OBJECTIVE: Anorectal malformations comprise a spectrum of anomalies that continue to be difficult to treat, even today. The aim was to evaluate the fecal continence of children who underwent posterior sagittal anorectoplasty due to anorectal malformations, via computerized anorectal manometry and profilometry. DESIGN AND SETTING: Prospective study at Universidade Federal de São Paulo. METHOD: 82 patients (56.1% boys; 43.9% girls) of mean age 85.5 months were evaluated. They were divided into continent, partially continent and incontinent groups. Age, sex, manometric variables and profilometric parameters were studied. The results were statistically analyzed. RESULTS: Among the 82 patients, 37.8% were continent, 25.6% were partially continent and 36.6% were incontinent. The overall mean resting pressure was 22 mmHg, and the means for the continent, partially continent and incontinent groups were, respectively, 30.7 mmHg, 23 mmHg and 14.7 mmHg. The overall mean pressure response to voluntary contraction was 56 mmHg, and the means for the groups were 65.4 mmHg, 55.8 mmHg and 46.6 mmHg, respectively. The rectosphincteric reflex was absent in 82.9% of the cases. In the profilometry analysis for all patients together, blue (20 to 50 mmHg) and yellow (50 to 80 mmHg) were predominant, and there was a similar distribution for the continent and partially continent patients. However, among the incontinent patients, green (< 20 mmHg) and blue prevailed. CONCLUSIONS: Manometric and computerized profilometric analyses were an excellent method for postoperative evaluations on patients with intermediate and high anorectal anomalies, and for therapeutic planning.
Downloads
References
Pena A, Devries PA. Posterior sagittal anorectoplasty: important technical considerations and new applications. J Pediatr Surg. 1982;17(6):796-811.
Sun WM, Rao SS. Manometric assessment of anorectal function. Gastroenterol Clin North Am. 2001;30(1):15-32.
Benninga MA, Omari TI, Haslam RR, Barnett CP, Dent J, Davidson GP. Characterization of anorectal pressure and the anorectal inhibitory reflex in healthy preterm and term infants. J Pediatr. 2001;139(2):233-7.
Goyal A, Williams JM, Kenny SE, et al. Functional outcome and quality of life in anorectal malformations. J Pediatr Surg. 2006;41(2):318-22.
Konuma K, Ikawa H, Kohon M, Okamoto S, Masuyama H, Fukumoto H. Sexual problems in male patients older than 20 years with anorectal malformations. J Pediatr Surg. 2006;41(2):306-9.
Funakosi S, Hayashi J, Kamiyama T, et al. Psychosocial liai- son-consultation for the children who have undergone repair of imperforate anus and Hirschsprung disease. J Pediatr Surg. 2005;40(7):1156-62.
Mishalany H, Suzuki H, Yokoyama J. Report on First Inter- national Symposium of Anorectal Manometry. J Pediatr Surg. 1989;24(4):356-9.
Martins JL, Pinus J, Pinus JQ. Manometria anorretal. In: Fa- gundes Neto U, Wehba J, Penna FJ, editors. Gastroenterología pediátrica. 2nd ed. São Paulo: Medsi; 1991. p. 805-11.
Cali RL, Blatchford GJ, Perry RE, Pitsch RM, Thorson AG, Christensen MA. Normal variation in anorectal manometry. Dis Colon Rectum. 1992;35(12):1161-4.
Martins JL. Avaliação pós-operatória de crianças portadoras de anomalias anorretais, submetidas à correção cirúrgica pela anor- retoplastia sagital posterior. [Thesis]. São Paulo: Universidade Federal de São Paulo — Escola Paulista de Medicina; 1993.
Martins L, Esteves E. Evaluación de la motilidad anorrectal por manometría computarizada en la infancia. [Functional anorectal evaluation with computerized manometry in children]. Rev Cir Infant. 1996;6(4):177-80.
Martins JL, Pinus J. Use of biofeedback (BFB) in the treatment of fecal incontinence after surgical correction of anorectal malformations by posterior sagittal anorectoplasty (PSARP). Sao Paulo Med J. 1997;115(3):1427-32.
Allen ML, Zamani S, DiMarino AJ Jr, Sodhi S, Miranda LA, Nusbaum M. Manometric measurement of anal canal resting tone: comparison of a rectosphincteric balloon probe with a water- perfused catheter assembly. Dig Dis Sci. 1998;43(7):1411-5.
Hanneman MJ, Sprangers MA, De Mik EL, et al. Quality of life in patients with anorectal malformation or Hirschsprung’s disease: development of a disease-specific questionnaire. Dis Colon Rectum. 2001;44(11):1650-60.
Boston VE, Scott JE. Anorectal Manometry as a diagnostic method in the neonatal period. J Pediatr Surg. 1976;11(1):9-16.
Bowes KL, Kling S. Anorectal manometry in premature infants. J Pediatr Surg. 1979;14(5):533-5.
Peña A. Surgical treatment of high imperforate anus. World J Surg. 1985;9(2):236-43.
Gordon PH. Anorectal anatomy and physiology. Gastroentereol Clin North Am. 2001;30(1):1-13.
Olsen AL, Rao SS. Clinical neurophysiology and electrodiag- nostic testing of the pelvic floor. Gastroenterol Clin North Am. 2001;30(1):33-54, v-vi.
Varma JS, Smith AN. Anorectal profilometry with the micro- transducer. Br J Surg. 1984;71(11):867-9.
Lestar B, Kiss J, Penninckx F, Istvan G,. Bursics A, Weltner J. Clinical significance and application of anorectal physiology. Scand J Gastroenterol Suppl. 1998;228:68-72.
Heikenen JB, Werlin SL, Di Lorenzo C, et al. Colonic motil- ity in children with repaired imperforate anus. Dig Dis Sci. 1999;44(7):1288-92.
Vaizey CJ, Kamm MA. Prospective assessment of the clinical value of anorectal investigations. Digestion. 2000;61(3):207-14.
Jorge JM, Wexner SD. Anorectal manometry: techniques and clinical applications. South Med J. 1993;86(8):924-31.
Schuster T, Lagler F, Pfluger T, Dietz HG, Joppich I. A computerized vector manometry and MRI study in children following posterior sagittal anorectoplasty. Pediatr Surg Int. 2001;17(1):48-53.
Rasmussen OO. Anorectal function. Dis Colon Rectum. 1994;37(4):386-403.
Langemeijer RA, Molenaar JC. Continence after posterior sagittal anorectoplasty. J Pediatr Surg. 1991;26(5):587-90.
Sundblad M, Hallbook O, Sjodahl R. Anorectal manometry with a microtransducer. Eur J Surg. 1993;159(6-7):365-70.
Sangwan YP, Coller JA, Schoetz DJ Jr, Murray JJ, Roberts PL. Latency measurement of rectoanal reflexes. Dis Colon Rectum. 1995;38(12):1281-5.
Tsuji H, Okada A, Nakai H, Azuma T, Yagi M, Kubota A. Follow-up studies of anorectal malformations after posterior sagittal anorectoplasty. J Pediatr Surg. 2002;37(11):1529-33.
Peña A, Hong AR, Midulla P, Levitt M. Reoperative surgery for anorectal anomalies. Semin Pediatr Surg. 2003;12(2):118-23.
Hool GR, Lieber ML, Church JM. Postoperative anal canal length predicts outcome in patients having sphincter repair for fecal incontinence. Dis Colon Rectum. 1999;42(3):313-8.
Taylor BM, Beart RW Jr, Phillips SF. Longitudinal and radial variations of pressure in the human anal sphincter. Gastroen- terology. 1984;86(4):693-7.
Williamson JL, Nelson RL, Orsay C, Pearl RK, Abcarian H. A comparison of simultaneous longitudinal and radial recordings of anal canal pressures. Dis Colon Rectum. 1990;33(3):201-6.
Keck JO, Staniunas RJ, Coller JA, Barrett RC, Oster ME. Computer-generated profiles of the anal canal in patients with anal fissure. Dis Colon Rectum. 1995;38(1):72-9.
Benninga MA, Wijers OB, van der Hoeven CW, et al. Man- ometry, profilometry, and endosonography: normal physiology and anatomy of the anal canal in healthy children. J Pediatr Gastroenterol Nutr. 1994;18(1):68-77.
Chen CC, Lin CL, Lu WT, Hsu WM, Chen JC. Anorectal function and endopelvic dissection in patients with repaired imperforate anus. Pediatr Surg Int. 1998;13(2-3):133-7.
Peña A, Hong A. Advances in the management of anorectal malformations. Am J Surg. 2000;180(5):370-6.
Hrabovszky Z, Dewan PA. Revision anorectoplasty in management of anorectal anomalies. Pediatr Surg Int. 2002;18(4):269-72.
Hallows MR, Lander AD, Corkery JJ. Anterior resection for megarectosigmoid in congenital anorectal malformations. J Pediatr Surg. 2002;37(10):1464-6.
Nakayama DK, Templeton JM Jr, Ziegler MM, O’Neill JA, Walker AB. Complications of posterior sagittal anorectoplasty. J Pediatr Surg. 1986;21(6):488-92.
Belizon A, Levitt M, Shoshany G, Rodriguez G, Peña A. Rectal prolapse following posterior sagittal anorectoplasty for anorectal malformations. J Pediatr Surg. 2005;40(1):192-6.
Rao SS, Patel RS. How useful are manometric tests of anorectal function in the management of defecation disorders? Am J Gastroenterol. 1997;92(3):469-75.
Moss RL. The failed anoplasty: successful outcome after reoperative anoplasty and sigmoid resection. J Pediatr Surg. 1998;33(7):1145-7; discussion 1147-8.
Rintala RJ, Lindahl HG. Fecal continence in patients having undergone posterior sagittal anorectoplasty procedure for a high anorectal malformation improves at adolescence, as constipation disappears. J Pediatr Surg. 2001;36(8):1218-21.
